Introduction
From F.R.A.M.E (International) ’s experience in the state of New South Wales, Australia, ‘medically substantiated’ child at risk notifications are poorly investigated or hardly investigated at all by the Department of Community Services (DoCS).

From our experience of conducting investigations of several notifications, and completing an analysis of several ‘completed’ DoCS investigations and a DoCS review report, F.R.A.M.E has identified the problems faced by DoCS and recognised the need to either undertake to conduct these investigations ourselves, or alternatively to support those parents who endeavour to investigate the notifications themselves while recognising that most parents outside of NSW will not have this support/ expertise available to assist them. With this in mind, F.R.A.M.E. has formulated a 12 step guide to either: a) investigating child-at-risk notifications, b) assessing the merit of an investigation currently underway or 3) assessing the merit of those investigations already ‘completed’ by DoCS staff.

Conceptualising the problem for DoCs

By DoCS own admission:

"There are no interagency guidelines or protocols available to  DoCS  and Health staff to assist them in managing the cross agency issues in cases involving alleged MSBP including processes of communication, notification or referral.."     

while recognising that:

"An effective multidisciplinary approach to identifying, confirming and confronting MSBP cases requires a planned, objective, coordinated response that can be put into effect immediately upon suspicion of a case. Current practice does not include a multidisciplinary DoCS/Hospital protocols to respond to these complex cases’

What is also extremely important to recognise is that DoCS staff are generally overworked and publicly unappreciated and are under enormous bureaucratic pressure to ‘close files’ rather than conduct thorough investigations of such notifications. In addition, individual DoCS investigating officers would appear to have very little, if any health related experience/qualifications and even less professional and personal will with which to investigate such notifications.

In F.R.A.M.E’s experience, individual DoCS officials are not likely to challenge, or even question the perceived individual and collective wisdom, objectivity integrity, or motivation of health practitioners (especially doctors) involved in the notification process and are even less likely to accept alternative ways to looking at ‘the problem’ when the person making the suggestion is not a health practitioner.

This naive ‘investigative’ approach to such cases that has been adopted by some DoCS officials is problematic especially when one considers that the alternative explanation to an accusation of child abuse could be: 

• the desire to conceal individual and collective involvement in the medical mismanagement of the child. 
• expediency.
• collegial loyalty.
• the desire to build a national/ international and hence potentially lucrative reputation as an ‘expert’ in MSBP and 
• to potentially ensure that the child remains under the care of the same medical treatment team, thus concealing the fact that the child has been medically mismanaged.
• What is also largely unrecognised is the ability of individual health practitioners (especially doctors) to influence and effectively undermine and compromise the actual DoCS investigation process, even when this runs counter to accepted and agreed upon Health Department and DoCS interagency child protection guidelines.

In a recent review of the concerns raised by one family, whose son was made subject to a notification to DoCS by doctors at Sydney Children’s Hospital, a DoCS review report highlighted the way in which doctors at Sydney Children’s Hospital were able to undermine the DoCS investigation process. Not only were these doctors able to have the parents and the parent’s advocate excluded from the second child protection planning meeting, in contravention of accepted child protection interagency guidelines, and to have the otherwise closed investigation file re-opened, but they were also able to affect the exclusion of the child’s general practitioners from the investigation and planning process. They were able to do this by bringing inappropriate pressure on the DoCS official to exclude the family and the family's advocate from the meeting, and in part, by making a false and unsubstantiated allegation of collusion on the part of one of the child’s general practitioners to DoCS during the actual notification.

"The decision to not have the ****** or their support persons present at the meetings, including the current treating doctors was made by the Assistant Manager at Corrimal CSC. The explanation given was that SCH wanted to discuss a newspaper article describing ****** as sick and so the investigation was still being undertaken; there was also resistance to the ******** involvement from SCH’ (Sydney Children's Hospital) (our ‘bold’ highlighting)

"A letter was also sent on the 12^th December 1998 to the SCH advising Dr Moran that the department would be ‘taking no further action at this stage." DoCS staff advised that following this letter, SCH advised that they did not agree with this course of action, as they had received further information, and a meeting was planned at SCH for 5/2/99’

This false and unsubstantiated allegation about one of the child’s general practitioners took the form of one of the notifying doctors alleging that the child’s general practitioner was ‘sympathetic to the mother’ even though this particular doctor had neither met with, or even talked to, the general practitioner concerned. By pejoratively dismissing the child’s general practitioner in this manner, the notifying doctor effectively undermined the personal and professional credibility of the general practitioner and the reliability and veracity of the information the child’s general practitioner was able to relay to the DoCS officer.

This positioning of the general practitioners as being suspect, and as having nothing worthwhile to contribute to the investigation process and ultimately to the health, welfare and safety of the child was never questioned by the DoCS officials. The reliability and veracity of this defamatory statement was allowed to stand as fact and was never tested, questioned or even bought to the attention of the general practitioner in question. The first time the general practitioner knew of the accusation was when the mother showed him a copy of the child’s DoCS notification intake sheet.

"Dr A confirmed that he was not invited to any case meetings in  regard to the notification. Furthermore, he advised the reviewers that he is most concerned that the Department file describes him and his colleague in the practice as "sympathetic", in a way that appears to imply that they are colluding with possible abuse of a child. He advised that this was the reason he had to make his concerns public. He believes child abuse is a criminal matter and that these "allegations about him and his colleague’s professional practice" are serious. He believed that the information they had to offer was never sought…This lack of consultation with general practitioners could have serious consequences for the management of child protection matters."

In addition, and as part of the ‘confirmation’ of abuse, notification and investigation process the child’s general practitioners were not:

• made aware of the suspicion or ‘confirmation’ of the abuse by the child’s then current treatment team which supposedly occurred in August/September 1997.
• made aware of the alleged referral of the child to the hospital’s child protection unit in October 1997
• made aware of, or invited to attend a child protection planning meeting that was supposedly conducted at the hospital in October 1997.
• Invited to attend, or made aware of a child protection planning meeting that was supposedly conducted at the hospital in February 1998.
• Made aware of the actual notification in June 1998.
• Invited to attend, or made aware of the first DoCS initiated and hospital facilitated child protection planning/investigation meeting in August 1998.
• Invited to attend, or made aware of a second child protection planning meeting that was held in respect of the investigation process at the hospital in February 1999.

The general practitioners were only made aware of the notification when the parents informed them of the fact in November 1998.

According to the DoCS review report:

"The Assistant Manager at Corrimal CSC advised that Dr B and Dr A were intentionally excluded because they were considered to be sympathetic to Mrs Smith…This decision is puzzling. These doctors had the ability to provide information that would assist in the assessment process. Drs B and A were also in an important position to assist with supporting and monitoring the child and family in relation to protection issues. Dr A himself raised this issue with the Review Team"

Interestingly, the general practitioners had information on file that was supportive of the parent's position, brought into question the medical management of the child, and cast substantial doubt on the motivation of the doctors involved in the notification process. The child’s general practitioner subsequently became the child and parent’s staunchest ally and did much to refute the allegation/confirmation of MSBP and protect the child from the proposed unnecessary and potentially damaging intervention by the State.

The effect of the allegation/confirmation of abuse on the credibility of the alleged offending parent(s).

It is the parent/grandparent/guardian who is generally thought to have abused the child in medically ‘substantiated’ cases of child abuse (especially mothers in Munchausen syndrome by proxy cases and fathers in Shaken Baby syndrome cases), and, as DoCS official’s interests are generally orientated toward the child who is the subject of the notification, they are unlikely to advocate on behalf of, or suggest ways in which the parent(s) can support and defend themselves.

From a number of cases that F.R.A.M.E has investigated we have collectively concluded that human nature, poor judgement, work place demands, notable individual failings and possible unprofessional personal and professional allegiances dictate that some DoCS officials are likely to:

• Breach major policy and procedural child protection guidelines
• Fail to conduct thorough investigations.
• Quickly close investigation files without review when the information supplied by the doctors is found to be questionable.
• Threaten to have the child taken into care unless the parent(s) ‘confesses’ to the allegation /confirmation of abuse.
• Play one parent off against the other on threat of taking away the child or/and limiting parental access to the child.
• Fail to inform the parent(s) of their rights.
• Attempt to deceive the parents about the DoCS investigation and child protection planning meetings processes
• Misrepresent what the parent(s) have said or done to each other and others including the court
• Fail to document in the child’s protection file information supportive of the offending parent(s) position
• Ignore obvious and indisputable shortfalls, contradictions and omissions in and from the testimonies of the health practitioners involved in the notification process especially if it is not supportive of the position that the child is a victim of abuse.
• Pervert the course of justice by failing to inform the child’s defence or/and present before children’s care court proceedings, information that refutes the previous allegation of abuse.
• Misrepresent or intentionally (?) misunderstand Health Insurance Commission (Medicare) data.

11 step plan

Accusations of this kind largely discredits, isolates and positions the perpetrator as ‘other’ and any thing the alleged perpetrator says or does in their defence is immediately held to be suspect, is considered to be without merit, and is largely discounted and disbelieved. Health practitioners (especially doctors) are held to be the ‘experts’ in such cases, and their testimony is largely accepted without question as being flawless, informed, credible, reliable, objective and relayed in the 'best interests' of the child. 

In F.R.A.M.E’s attempt to assist parents to individually and collectively protect their child(ren) from unnecessary State intervention, defend themselves from false allegations of child abuse, protect families from false and malicious accusations of child abuse and ultimately to protect the integrity of the child protection process by promoting effective child protection guidelines; F.R.A.M.E has developed this 12 step plan:

Step 1: Documentation

From the first moment you suspect/learn that the therapeutic relationship that you are having with your child’s doctor/treatment team is breaking down, or you have been suspected/accused of abusing your child., It is absolutely essential that you start documenting everything you say or do that has bearing on your child and your child’s health care. In particular, it is absolutely crucial that you document the name of the person that you have spoken to, their phone number, their position/title, and the department from which they are calling. Keep brief notes in point form about what was said and record the time and date of every phone call or conversation that you make or receive in relation to your child or the notification.

It sounds trivial but we highly recommend that you buy a file with transparent plastic sleeves with which to store the letters in chronological order and a diary adequate to record conversations and keep the diary close to the phone so you won’t forget to document the telephone call. 

Keep photocopies of these documents in a separate location as you do not know who the notifier is, you do not know the motivation of the notifier, and in most States, counties and countries you will never know the identity of the notifier. It may be a family member or ‘friend’ who has a vested interest in you being accused of child abuse, losing custody of your child, and being potentially removed from the family home.

Step 2: Gathering information.

Learn all you can about the type of abuse that you are accused of perpetrating by accessing medical textbooks from your local university medical library. If you can afford to, buy a computer and access the internet. Alternatively book yourself on the computer in the local library and ask the librarian to help you conduct searches. See list of helpful websites and search words 

Essential to any investigation is the gathering of information, which ideally should be done prior to the notification, following the notification, and certainly BEFORE the matter is referred to the Children’s care court (If it gets that far).

Some states and countries allow people to access certain information under certain acts of parliament and it is crucial that you contact your local community legal centre, the local magistrate, or/and the government department involved to find out what information is accessible. Seek to access and keep on accessing the following information:

• The Child’s clinical medical file from any hospital
• Your child’s clinical files that are held by private doctors (Usually only  accessible via subpoena. Will become accessible in NSW in December 2001 when the new Privacy Act is ratified )
• The child’s general practitioner’s medical file(s). (Again usually only  accessible via subpoena. Will become accessible in NSW in December 2001 when the new Privacy Act is ratified )
• Any hospital child protection file
• The Department of Community Services (or equivalent) file
• The hospital’s child protection file (if the child has been referred to a child protection unit)
• The hospital file tracking record or equivalent (This record tells you when and who has accessed your child's file. Not all hospital's have implemented such a system)
• A copy of the State or county health department’s child protection/interagency guidelines policies and protocols which are ordinarily available from the State/central library or from DoCS themselves.
• A copy of the Department of Community Services (or equivalent) investigation policies and protocols.
• A copy of the Act of parliament that governs the action of the Department of Community Services, the health department, the Medical Practice Act (or equivalent in your State/Territory or Country). These are generally available from the internet. Go to your local library and seek help/advice from the librarian
• The hospital code for the type of abuse that you have been accused of. We have found that a code for MSBP does not exist within the system in NSW. Therefore there is no effect way of knowing just how many cases they have per year. If the code exists, obtain comparative data from other children’s hospitals by hospital specialty department.
• The specific code for the type of abuse that you have been accused of and which is used by the Department of Community Services (or equivalent). (We rang a number of DoCS offices and we were surprised by the variation).
• Your child’s and your health insurance (Medicare) records (in Australia) (if available).
• The child’s Department of Education file (if they are of school age) (If there is any suggestion that any of the doctors contacted the child's school).
• If this matter goes before the children’s care court, go with documents seeking an immediate appeal should the decision go against you and seek to obtain a copy of the court transcript whatever the court decision. If the decision goes against you and the child is made a ward of the State, immediately file an appeal and seek to retain custody/care of the child pending the appeal. Seek information from the clerk of the court about how to do this, BEFORE you go to court.

When you are informed that your child has been made the subject of a notification, it is absolutely crucial that you seek to obtain the child's DoCS file and attend any meeting that is held in relation to your child. The DoCS file should include various documents, one of which will be an intake notification sheet and assessment plan (or equivalent). Find out what documents should constitute a DoCS file in your state/ territory, county or country.

There will be at least one, if not several child protection/investigation meetings held in relation to your child and if it absolutely imperative that you attend everyone. You need to ask your DoCS worker when and where they are so you can attend. If your child’s DoCS worker:

• Will not inform you as to the date/location of the meeting.  
• States that you do not have to attend. 
• States that there is not going to be a meeting. 
• States that you cannot attend. 
• States that you need not attend.
• States that the planned meeting is not a child protection planning meeting.

Contact the DoCS worker’s line manager and seek a written explanation for your planned exclusion form the meeting.

From our experience, and we cannot stress this enough, it is absolutely essential that you attend all of these child protection planning/investigation meetings and take a credible and skilled support person/note taker with you who is willing and able to attend and to take concise and reliable minutes of the meeting. Ask for a postponement of the meeting if your support person/note-taker cannot attend on the day/time set by the DoCS worker. If you value your child, THIS IS NOT THE TIME TO SCRIMP AND SAVE. It is absolutely essential that this minute taking is accurate.

Alternatively, seek to have the session  recorded and make back-up copies of all recordings and minutes taken. Supply a copy of the recording or the minutes to DoCS and in the case of the minutes, seek written verification from the DoCS officer that these minutes were an accurate reflection of what was said at the meeting. Finally, seek to have your child's DoCS worker send a copy of the minutes of the meeting to all attendees and for them to sign  copies of the minutes verifying their accuracy of the minutes.   

From F.R.A.M.E's experience of case study 1, the Independent Commission Against Corruption (I.C.A.C.) was able to obviate it's responsibility to investigate the parent's claim that the doctors involved in the notification and child protection planning meetings had maliciously notified their child to DoCS, and had consistently and knowingly provided false, misleading, contradictory, incomplete and inaccurate information to DoCS in respect of these processes, by bringing into question the reliability and veracity of the information gathered by a DoCS officer during a child protection planning meeting.

"Apart from expert medical evidence, Mrs *******'s complaint of corruption turns on circumstantial evidence, principally around the timing of the child at risk of notification to the Department of Community Services. She maintains there was a 10 month delay from Dr ********'s first diagnosis and suggests that the explanation for the delay must be malicious motivation (sic). This appears to be based on notes of a case meeting on 5 February 1999 apparently taken by a DOCS officer, to the effect that Dr. ****** "quickly" picked up Munchhausens. (sic). The accuracy of these notes as evidence of the matters discussed at the meeting is open to question given the time and circumstances under which they were taken." (Kieran Pehm Deputy Commissioner I.C.A.C June 14, 2001)  (Our bold highlight).            

What is significant about Mr Kieran Pehm's decision is that: 1) there was no evidence to suggest that the minutes of the meeting had not been written contemporaneously, and 2) there was no evidence to suggest  that the 'circumstances' of the meeting and the timing of the minute taking was in any way unusual. At the time of writing, the family are still awaiting Deputy Commissioner Pehm's rationale for I.C.A.C's  decision. Hypocritically, accountability and transparency of decision making do not appear to be a feature of the I.C.A.C's process, despite I.C.A.C's promotions of these ideals within other government departments. Despite this however, the family have nothing but praise for the individual professional competency, diligence and personal integrity of Ms Michelle Calvert, the former I.C.A.C senior investigation officer who conducted the preliminary investigation of this complaint. Her professionalism exemplified the ideals promoted, but not adhered to, by I.C.A.C.

Take note of who has been invited/made aware of the child protection investigation/planning meetings and ask why they are there especially if they have had no involvement in the child’s care. They might just have been invited to make it appear that there is a consensus of opinion and that there are a number of people who are aware and involved in the notification. Ask the attendees at the meeting who invited them to the meeting, and why they are there. Bring this fact to DoCS’s attention and ask for an explanation. Seek to have this questioning included in the account of the meeting. (See Getting the best out of child protection planning meetings)

Take note of anyone who is likely to acquiesce to what is being said as a result of a relatively junior position to the accuser, one who is weak (emotionally and/or socially), one who adheres to collegial alliances, and anyone who is new to the treatment team. Ask them directly if they have ever met your child or have any personal information that would refute/contradict the diagnosis/ accusation/ confirmation of abuse and have this inserted in the minutes of the meeting. Advise them that should this matter go to court and they are private practitioners, that you will subpoena their private clinical files.

Familiarise yourself with DoCS’s policy and procedural manuals and Health’s child protection interagency guidelines. Learn all you can about DOCS’ processes and procedures and make sure they are implemented. Ensure that your child has a DoCS initiated care plan, an independent developmental and psycho-social assessment, and that the perpetrator of the alleged abuse of the child receives a psychiatric assessment if these are part of the identified process.  

Write to DoCS and seek written clarification of all the documentation that the department has obtained and the names of all the people that DoCS have spoken to in respect of the notification. If you can identify people or/and information that DoCS has not spoken to or/and obtained information from, write to DoCS and provide them with this information. Obtain an acknowledgement of this correspondence.

Currently in NSW., Australia the notification is inadmissible as evidence in any other court other than the children's care court. When you obtain a copy of the notification, seek to have the notifying doctor(s) repeat their accusation/ confirmation of abuse in writing and in reference to the child's file. Seek to have them source their accusations, naming names, dates and occasions when these allegations are supposed to have happened. These documents are then admissible in civil and criminal courts.  

Step 3: Sharing information and formulating alliances

Accusations of this kind alienates and distances the alleged perpetuator from the very people who can support/assist them in this matter.

Show the information obtained from the DoCS file to your child’s general practitioner and the child's other specialists and ask them if they agree with the accusation or have any correspondence that contradicts the notifying or participating doctor’s account of events. Do not assume that your child’s other treating doctors are aware of the accusation/notification and are in agreement with what has been said about you or your child.

Do not assume that everyone who is invited to attend the child protection planning meetings and who is asked to convey information to DoCS is knowledgeable about 1) your child and your child’s health care, 2) the circumstances surrounding the accusation/ notification and is in agreement with what has been said about your child or your assumed role in the alleged abuse.

Take note of who is not invited to, or made aware of the child protection planning meetings (especially the child’s current treating doctors and notable past treating doctors). Do not assume that they are aware of the accusation/ confirmation of abuse, the notification, the child protection/investigation meetings, or are aware or are in agreement with what is being said or done on their behalf. Write to them as individuals informing them of what has been said, done or written on their behalf, and have them know that should the matter go to court you will have them cross-examined on these points.

Step 4: Preparation and submission of information

On receipt of the clinical, child protection and DoCS file, start preparing a documented chronology history of :

• The child's clinical history inclusive of documentary evidence from the child's clinical file (eg operation notes, pathology results, investigation reports, clinical file entries) 
• The events leading up to the accusation of abuse/notification (see example of this process document A).
• The DoCS process from notification (see example of this process document B).

If you have transferred your child's care over to another hospital/health practitioner since the accusation/confirmation of abuse and the notification, and there has been a notable improvement in the child's health that can be measured in terms of the child's weight gain, document this on a relevant child weight/height chart (see example of this process document C) 

Step 5: As far as you can, check that the health practitioners involved in the accusation/confirmation of abuse and the notification process have not given false, misleading, and contradictory information to DoCS in respect of the notification and child protection planning meetings, and ensure that all relevant information has been given to DoCS. 

From our experience there are often notable discrepancies in, and notable omissions from the information given to DoCS in respect of the notification and during the child protection planning meetings to that which appears on the child’s hospital, child protection, and private doctors clinical files. We recommend that you painstakingly go through the information provided to DoCS by the health practitioners concerned, cross-referencing this information with the information already given to DoCS and obtained from the child’s clinical files, documenting the omissions, misrepresentations, conflicting evidence and deliberate fabrications. Give a witnessed copy of this document to DoCS. Ideally have a health professional who is prepared to witness the document go through this information with you .

Case study 2

Case study two involved the accusation that a mother had induced her child’s coagulation problem by injecting him with excessive doses of heparinised saline and her child was duly notified to DoCS by Dr. Bohane (consultant  gastroenterologist as Sydney Children’s Hospital) as being a child at risk of MSBP (See DoCS de-identified child notification intake sheet). 

Following Dr Bohane's notification of the child to DoCS as suffering from MSBP, Dr Bohane followed up on the notification on August 22, 1995 by writing to DoCS on August 24, 1995. In his letter he wrote: 

"Professor Marcus Vowels, Haematologist was able to give me the expert opinion that this coagulation abnormality was due to Heparin and excessive doses of Heparin" (*****: 24/08/95) (See child de-identified letter)

However, in a letter that Dr Bohane subsequently wrote to DoCS (51/2 months later on February 6, 1996 (see child de-identified letter), following an investigative interview that DoCS conducted with Dr Bohane on 19th October, 1995., Dr. Bohane not only refuted his original assertion to DoCS that he thought that the child was suffering from MSBP but he also  refuted his earlier assertions to DoCS that he had spoken to Professor Vowels and that it had been Professor Vowels who had formed the ‘expert opinion that the child's coagulation problems could only have been attributable to "excessive doses of heparin". 

In his later letter to DoCS, Dr. Bohane  was now claiming that it was the "resident medical staff" who "on consultation with" with Professor Vowels, had: 

"formed the opinion that the coagulation disturbance could only have been caused by intermittent excessive doses of an anticoagulant heparin" (*****: 6/02/1996)

The only file entry that Prof. Vowles wrote in the child’s clinical file was as follows: 

"The MCV has been normal and the blood is not diamorphic…he does not have fe deficiency anaemia. Anaemia over the last 2 days is most like (sic) related to acute infection" (Vowels 8/8/95)

As you can see, this later statement by Dr. Bohane completely contradicts his earlier accusations and assertions about the mother and the child to DoCS, and yet this remained unexplored by DoCS. Interestingly, on review of the child’s clinical file there was no mention in the clinical file of any of the resident medical staff formulating this opinion that the coagulation disturbance could only have been caused by intermittent excessive doses of an anticoagulant heparin. 

For those of us who are health practitioners, these clinical opinions by Prof. Vowles and the resident medical staff would appear to be notable omissions from a child's clinical file and warrant explanation. There is no evidence to suggest that Prof. Vowles was ever aware that any of the treating doctors at SCH thought the child was being given an overdose of Heparin.

When this matter came before the children’s care court, the parents allege that DoCS failed to give a copy of Dr. Bohane's second letter to the child’s defence team and it was not tabled in the children’s care court by the DoCS officers involved. The child was made a temporary ward of the state. F.R.A.M.E. is unable to confirm this allegation as the tape recording of children's care court proceedings are destroyed after four years and a transcript of the court case does not appear on the child's DoCS file. 

The Department of Community Services, the Independent Commission Against Corruption (I.C.A.C) and the Health Care Complaints Commission (H.C.C.C) are all currently refusing to investigate this case (see fuller account of events leading up to this child’s notification case study 2).

Step 6: Check that DoCS has correctly interpreted the information that they have gathered as part of the investigation. 

Even when DoCS officials seek to obtain medical information in respect of notifications they lack the professional competence or motivation to analyse the information properly and to arrive at a reliable and credible analysis of the data.

Following the notification of one child to DoCS in respect of the confirmation of MSBP, and presumably in response to the notifier's assertion to DoCS that the mother had been 'presenting herself unnecessarily to doctors' and had been presenting the child to 'different doctors and specialists'; DoCS sought to obtain the 'Medicare' or Health Insurance Commission (HIC) data.  

On receipt of the HIC data, the DoCS investigation officer's not only grossly inflated the number of specialists that the child and mother had seen, but they also failed to check on the specialty of the doctor concerned or to take into consideration the referring agent. A large percentage of the doctors that the child and mother had seen were procedural specialists such as radiographers, pathologists and anaesthetists and most of the referrals were made by the same few doctors. (Case study 1 letter to Carmel Niland June 21, 2000)... The Health Insurance Commission sought to distance themselves from this fiasco with the following statement:

N/B Please note this information was sent to DoCS without any comments from the HIC regarding the number of  practitioners who provided services to either **** or ****  (HIC 2001)(Name of Parent and child  omitted)"

Given the mother's own substantial and well documented history of a number of immunology disorders and RSD, and the child's well established clinical history, the number of doctors that this mother visited and took her child too  was grossly normal. Interestingly, given that the notifying doctor did not access the mother's medical files, did not speak to any of the mother's specialists, and did not access the mother's HIC data,  the parents and F.R.A.M.E are at a loss to understand how he had arrived at this summation.

Step 7: Developing safeguards

Do not go to a psychiatrist nominated by DoCS even if they agree to pay for the psychiatric evaluation. Always find your own psychiatrist who is not paid by DoCS and who can provide you with an independent and unbiased evaluation. Let this psychiatrist know what you are being accused of and have them document this in the report. Again, while these assessments and reports can be expensive so is legal advice if it goes any further and you have to fight this matter in court. Ensure that you keep the original documents and send copies to DoCS. Ask for an acknowledgement of any documents received by the department.

Step 8: Formulating your child's defence.

If your child does things like stops breathing, vomits or develops bruising in your presence, which the child’s doctor alleges is indicative of abuse and which you know happens even in your absence., Organise to have your child videotaped while in the care of someone you can trust and in your absence, and have them sign a Statutory Declaration to the effect that these events have occurred while you were not there. Ideally, this person should be a health practitioner such as a doctor, nurse or social worker. Pay for this service from a reputable nursing agency/ medical service if necessary.

If you are accused of doing such a thing as injecting your child with a hypodermic containing a bacterium that you supposedly collected from the back of your throat so inducing skin lesions on your baby's body, have your doctor take throat swabs from the back of your throat to test for the bacterium. Do not believe the notifying doctors who claim that 100% of people grow the bacterium in the back of their throats, they probably don't. Then seek to obtain information and understand your genetic inheritance by questioning surviving members of your extended family. You will probably not be surprised that a number of your family members have a history of similar lesions and immunology disorders....

If your child has a complicated medical history, and one has not already been done, compile a medical summary of your child’s care to date that names the doctors involved in your child’s care and the test and investigation results that are supportive of your assertions. If you do not understand what has been written, look up the words in a medical dictionary or ask a health practitioner to explain them to you.

If a medical summary already exists, painstakingly go through the summary cross-referencing it with the information on file and obtained from third parties and highlight any omissions, mistakes and factual errors. If you find notable omissions, factual errors or contradictory statements, ask for an explanation from the person who compiled the summary. Have a credible, reliable person go through the medical summary with you, prepare an amended summary and have that person countersign it as a Statutory Declaration as to it’s accuracy and authenticity.

If, on receipt of all of the available information and having spoken to all the people named by you DoCS proceeds to obtain a medical review from a DoCS medical reviewer, seek to have DoCS appoint an independent reviewer from DoCS even if you have to pay for it yourself. Alternatively, seek a written assurance that DoCS will make available to the medical reviewer all of the information that has been provided to the department. 

As part of the review process:  1) seek to have the medical reviewer access the child’s medical files, child protection file and the files of any private practitioners., 2) seek to have the medical reviewer provide details of the information sources that informs the review report and 3) seek to speak to the reviewer. Do not fail to obtain a copy of the review report.

In a recent case in New South Wales the parents were able to cast significant doubts on the integrity and objectivity of the medical reviewer, and bring into question  the reliability and veracity of the review report, by showing that the medical reviewer had ‘confirmed’ the original accusation of MSBP:

• without reference to the child’s clinical or child protection file(s).
• without the benefit of a psycho-social and developmental assessment of the child.
• without a psychiatric evaluation of the mother.
• without conferring with any of the child’s then current treating doctors.
• without being made subject to any identified DoCS medical review guidelines
• when he wasn’t asked to do so. The medical reviewer was asked to comment on the appropriateness of the medical management of the child who had a complex gastroenterology history and was not asked to comment on the appropriateness of the accusation/confirmation of MSBP.
• and undertook to comment on the medical management of the child when, as a paediatrician and not a gastroenterologist, the medical reviewer was not qualified to do so. 
• and then attended the second DoCS facilitated child protection planning meeting at the hospital.

DoCS does not have guidelines for their medical reviewers and this is one of the issues that F.R.A.M.E has addressed with the Department. The DoCS reviewer was made the subject of complaints to the Health Care Complaints Commission (NSW., Australia)., a complaint to the Independent Commission Against Corruption (NSW., Australia) ., and is currently the subject of a a civil law case that has been commenced by the child’s parents.

If, it seems likely that DoCS are going to take this matter to the children’s care court, or your child has already been made a ward of the state., contact your local community legal centre and ask them to recommend a legal firm that has already run legal cases against DoCS (or the equivalent). Alternatively, access the equivalent of Australia's Law-link legal site on the internet and see which law firms in your country/area have already run cases against DoCS (or your country's equivalent). Ask your local librarian to help you. You need expert legal advice from a firm who knows the vagaries of DoCS processes. Ideally the law firm would have already run medically substantiated cases of child abuse before. Ask them if they have before you contract their services

Step 8: Do not confess to something that you have not done, or agree to something that you do not understand.

Never ever confess or agree that you have done something to your child that you haven’t done, even if it is offered as a pre-condition for you keeping your child. In addition, if this matter goes to the children’s care court (or equivalent) do not sign an agreement that your child is in any ‘need of care’ or should remain with the current treatment team as a pre-condition to keeping your child. 

As previously discussed, the parents of one child who was subsequently made a temporary ward of the state claimed that they were tricked into signing a care order stating that the child was in 'need of care' by their solicitor, who they allege advised them that as the child was still in need of 'medical  care' that it was OK to sign the court order. What they did not realise was that they were signing a form that stated that they agreed that their child was in need of DoCS care..... 

Step 9: Safeguarding the judicial process and protecting your child during and after the court process.

If this matter goes to court assume there is a likelihood that your child will be made a ward of the State, even on a temporary basis. Be prepared to offer the court alternative care arrangements for your child. Ask trusted family members/friends if they would be willing to care for your child and obtain personal, employment and financial references and police checks of these people for presentation to the court on the day of the judgement.

If the matter is referred to the children’s care court, seek to have all of the practitioners who 1) participated in the actual notification., 2) participated in the child protection planning meetings, and 3) who are referred to in any correspondence to DoCS, repeat the accusations in the court. By making them repeat the accusations in court they will no longer be protected against prosecution for providing false and misleading information by the various provisions of the child protection legislation.

Have them cross-examined by your legal representative and at the end of the court hearing seek to obtain a transcript of the court case. If you cannot afford a copy of the transcript straight away, seek to find out how long the court keeps the tape recording. Again, as previously mentioned tape recordings of the court proceedings are only kept for four (4) years. 

If the court makes a care order on behalf of your child, ask the court to outline the conditions under which the child can remain at home. If the court decides to make your child the subject of a temporary care order and as a condition of that care order permits the child to remain in your partner's care, do not  consent to your child remaining a patient of the treatment team that made the notification if you are of the opinion that your child has been medically mismanaged, and especially if it is offered as a precondition for keeping your child. Try and reach a compromise position with the court for the child’s treatment to be transferred over to another team at the same hospital.

If your child is made a ward of the State, write to DoCS (or their equivalent) and advise them you will hold the department responsible for the health, safety and physical welfare of your child and that you will seek a full Coroner’s inquest should your child die.

Step 10: Protecting your child and yourself in the future.

As always, this section is in progress and is constantly being updated as new information comes to the attention of F.R.A.M.E. Meanwhile the information is as follows:

• Ideally always take a third person to any future doctor or health practitioner’s appointments. Document the purpose of the consultation, the referring doctor (if appropriate) the date and time of the consultation and what was said and done to the child.
• If someone makes, or offers you an appointment for your child without your knowledge or agreement, ask that person who made the appointment and question the purpose of the appointment. Be wary of accepting any appointments from hospitals that used to look after your child, especially if you have already transferred your child's care to a new hospital.
• Do not act as the conduit for information between health practitioners. If any health practitioner asks you to convey any information to any other health practitioner, ask them to provide a report or to write it down for you. Ask for a copy of any document to be sent from practitioner to practitioner.
• If you are accused of filling a syringe and injecting your child with saliva as a way of infecting your child, have an independent doctor (one who is not aware of the accusation/confirmation of abuse) take throat swabs and obtain a copy of the results. Do not believe anyone that says the bug that infected your child is present in 100% of all people.
• If one of your children dies, have an independent autopsy performed and seek to have a coronial inquest..

Step 11: Protecting your own and other people's children in the future.

Join F.R.A.M.E and become an active and financial member of an organisation that is actively involved in protecting children and their parents from false, vexatious and malicious allegations of child abuse and helping to identify the flaws in, and maintain the integrity of, the child protection system.